Aug 2026· Pharmaceutics· 0 citations· 178 references
TL;DR
Epilepsy is increasingly recognized as a multiscale network disorder rather than solely a condition of neuronal hyperexcitability, and the coordinated use of complementary human-relevant platforms may help incorporate multiscale mechanistic insights into therapeutic development and evaluation, narrow persistent translational gaps, and support more predictive and mechanism-informed treatment strategies.
Abstract
Background/Objectives: Epilepsy remains a major neurological disorder, with approximately one-third of patients continuing to experience pharmacoresistant seizures despite the availability of numerous antiseizure medications (ASMs). While current therapies primarily target neuronal hyperexcitability through modulation of ion channels and neurotransmitter systems, increasing evidence suggests that epileptogenesis arises from multiscale interactions involving molecular, cellular, circuit, network, neuroinflammatory, and neurovascular mechanisms. Although therapeutic strategies have diversified, this expanded mechanistic understanding has not yet been fully incorporated into therapeutic development and evaluation. This review integrates current knowledge of multiscale epilepsy pathophysiology with recent therapeutic advances and emerging experimental platforms. Methods: This narrative review synthesized literature identified primarily through PubMed and Google Scholar searches through January 2026, supplemented by targeted updates of therapeutic development and regulatory status through July 2026. Particular emphasis was placed on ion channel modulators, synaptic and neuromodulatory therapies, neuroinflammatory interventions, precision genetic approaches, and human-relevant experimental platforms, including induced pluripotent stem cell (iPSC)-derived models, brain organoids, multi-electrode arrays (MEAs), organ-on-a-chip systems, multi-omics technologies, and artificial intelligence (AI)-based analytical frameworks. Results: Current and emerging therapies target increasingly diverse molecular, circuit, neuromodulatory, and neuroinflammatory mechanisms. However, drug resistance remains multifactorial, and the long-term effects of therapeutic interventions on network remodeling, neuro-glial interactions, and sustained clinical response remain incompletely understood. NAMs provide complementary capabilities for patient-specific disease modeling, functional network phenotyping, neurovascular modeling, and the integration of molecular, electrophysiological, and computational data across biological scales. Conclusions: Epilepsy is increasingly recognized as a multiscale network disorder rather than solely a condition of neuronal hyperexcitability. The coordinated use of complementary human-relevant platforms may help incorporate multiscale mechanistic insights into therapeutic development and evaluation, narrow persistent translational gaps, and support more predictive and mechanism-informed treatment strategies.
Current evidence supports a shift from empirical seizure suppression toward mechanism‐guided and individualized care, and future progress will require closer integration of molecular discovery, validated biomarkers, and real‐world implementation to achieve earlier, more equitable, and potentially disease‐modifying treatment.
Epilepsy is a heterogeneous neurological disorder affecting more than 70 million people worldwide, posing significant challenges for clinicians due to its complex etiology, diverse manifestations, variable treatment responses, and the inability to predict seizures or disease onset reliably. Despite advances in antiseizure medications, approximately 30% of patients remain treatment-resistant, highlighting the urgent need for therapies with antiepileptogenic or disease-modifying effects. To optimize and individualize strategies to predict and treat seizures and epilepsy, efforts to identify biomarkers of epilepsy risk, epileptogenesis, seizures, and therapy response are ongoing. This article reports key presentations and discussions from the 2023 Workshop on Neurobiology of Epilepsy (WONOEP XVII) in Kilkea, Ireland on novel epilepsy biomarkers and treatment strategies beyond the synapse and does not constitute a comprehensive review of biomarkers or treatment strategies. Much of the focus in epilepsy research has centered on identifying primarily neuronal processes or components. The 2023 WONOEP presentations discussed advances in plasma biomarkers for posttraumatic seizures and outcomes, perivascular spaces in posttraumatic epilepsy and poststroke epilepsy, imaging biomarkers of astrogliosis, and plasma microRNA biomarkers of intellectual disability and autism in tuberous sclerosis complex. Furthermore, research on immuno- and anti-inflammatory therapies and blood-brain barrier in drug-resistant focal epilepsies and infantile epileptic spasms syndrome was presented, as well as on the effects of antiseizure and cardioprotective medications on cardiac injury in temporal lobe epilepsy. The review also emphasizes the need for further interdisciplinary collaboration to accelerate the translation of these findings into clinical practice, ultimately improving outcomes and quality of life for people with epilepsy.
Mirte Scheper, Zining Liu, A. Galanopoulou et al.· Epilepsia· 0 citations
This review synthesizes advances in neuroimmunology, clinical phenotyping, diagnostics, immunomodulatory and antiseizure therapies, neuromodulation, and patient and family centered outcomes, and outlines future directions focused on biomarker-driven precision medicine, disease-modifying strategies, and interdisciplinary care models.
Alica M. Goldman, Nora Wong, A. Vezzani et al.· Epilepsy Currents· 0 citations
Epilepsy is a chronic neurological disorder prevalent worldwide, characterized by recurrent episodes of epileptic seizures. The primary current treatment approach is pharmacological, aimed at reducing the intensity and frequency of seizures, though it does not provide a cure. Neuroinflammation plays a central role in epilepsy by activating glial cells and stimulating the release of inflammatory mediators, further disrupting the balance between excitation and inhibition, thereby promoting the onset and recurrence of seizures. Furthermore, persistent inflammatory processes induce synaptic remodeling and the formation of dysfunctional neural circuits, establishing a pathological cycle in which inflammation and epileptic activity feed into each other. In this regard, natural products represent an important avenue for the discovery of new treatments. Thus, this review aimed to relate the role of the main inflammatory targets (Inflammasome/NLRP3, NF-κB, MAPK, mTOR, COX-2/PGE2, and TLR4/HMGB1) to epilepsy and to investigate in the literature natural products acting through these pathways in the treatment of epileptic seizures. Consequently, inflammatory pathways have emerged as critical targets in epilepsy, highlighting the importance of strategies capable of modulating neuroinflammatory processes. In this context, natural products stand out as promising therapeutic alternatives, given their multitarget mechanisms of action, potential to attenuate neuroinflammation and neuronal hyperexcitability.
A. L. Dias, P. R. da Silva, L. R. P. Souza et al.· International Journal of Mol...· 0 citations
Epilepsy is a common and heterogeneous group of neurologic disorders characterized by recurrent unprovoked seizures. With a diverse array of genetic and acquired etiologies, the mechanisms linking insults to epileptogenesis and network hyperexcitability remain poorly understood. Although animal models have provided critical insights into seizure generation and disease mechanisms, differences in human cortical development and limitations in recapitulating spontaneous seizure phenotypes observed in patients highlight the need to develop complementary human-based models. Human pluripotent stem cell-derived brain organoids, including patient-derived and CRISPR-engineered models, offer an increasingly powerful human-specific platform to investigate epilepsy-associated disruptions in neuronal production and differentiation, interneuron migration, and network activity. In this review, we discuss recent advances and ongoing challenges of human cortical organoid models of genetic and acquired epilepsies. Together with established animal models, organoid-based approaches hold promise for advancing mechanistic understanding of epilepsy and enabling the development of more precise therapeutic strategies.
Miranda Walker, Jack M. Parent· Epilepsy Currents· 0 citations
Epilepsy remains a major neurological disorder characterized by unpredictable seizures and cumulative comorbidities that even endure with standard pharmacotherapy. Conventional antiepileptic drugs (AEDs) are constrained by two interrelated barriers: limited brain penetration due to the blood-brain barrier (BBB), which necessitates high systemic dosing and peripheral toxicity, and a narrow mechanistic focus on neuronal ion channels and synaptic receptors. This neuron-centric view overlooks non-neuronal drivers, such as neuroinflammation and BBB dysfunction, that sustain epileptogenesis and contribute to drug resistance in roughly one-third of patients. Nanomedicine addresses these limitations through a fundamentally different approach. Leveraging the unique advantages of nanocarriers, including facile synthesis, surface modification, and receptor-mediated BBB transcytosis, nanoparticles have evolved from passive delivery vehicles into intelligent, multifunctional therapeutic platforms that actively engage with disease biology. In this Perspective, we first delineate the inherent limitations of conventional AEDs in target selection. We then highlight how emerging nanomedicines are expanding the therapeutic target repertoire to include key non-neuronal nodes, with a focus on neuroinflammation and BBB repair. Finally, we offer a forward-looking perspective on two emerging frontiers: modulation of metabolic dysregulation and the microbiota-gut-brain axis, as well as the development of theranostic nanoplatforms that integrate real-time seizure monitoring with closed-loop intervention. Through this discussion, we aim to inspire a reorientation of nanomedicine strategies toward precision therapy for epilepsy.
Yage Sun, Wenguang Liu· Journal of Controlled Releas...· 0 citations